Fatal hypocalcemic, hyperphosphatemic, metabolic acidosis following sequential sodium phosphate-based enema administration.
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Acidosis↗
Biomedical subjects
R S Ford
Publications and source records attributed to R S Ford.
Laparoscopic-assisted colon resection.
The popularity and success of laparoscopic biliary tract surgery have persuaded surgeons to explore other applications for rigid endoscopic surgery. From July 1990 to February 1993 a total of 65 patients (mean age 57 years; range 41-82) underwent attempted laparoscopic colon resection. Indications for surgical intervention included cancer (39), adenomatous polyps (14), diverticulosis (10), stricture (1), and foreign-body perforation (1). A laparoscopic-assisted technique whereby the specimen was removed and the anastomosis was completed outside of the abdomen was used in all patients. A dilated umbilical opening was used for right-sided lesions and a left-lower-quadrant muscle-splitting incision for descending and sigmoid colon resections. Two patients required conversion to open laparotomy. There were no deaths and only four complications (pneumonia 1, urinary tract infection 1, prolonged ileus 1, and subfascial abscess 1). The mean postoperative stay was 4.4 days (range 3-8 days) and the average interval for return to normal activity was 8 days. Laparoscopic-assisted colon resection appears to be a safe and beneficial option for many patients with pathologic disorders of the large intestine. Future clinical trials are needed to fully determine the appropriateness of this procedure in patients with localized malignancies.
Adult↗
Pancreaticogastrostomy: preferred reconstruction for Whipple resection.
Anastomotic leak is the main complication after Whipple procedures. We reviewed retrospectively our experience with pancreatic cancer patients treated with Whipple resection and reconstruction with a pancreaticogastrostomy (PG) or a pancreaticojejunostomy (PJ). Ten patients operated between 1966 and 1990 composed the PJ group. Eight patients operated recently made up the PG group. Data on age, length of stay (LOS), survival, and complications (early and late) were noted from patient's charts. Patients in the PJ group had an average age of 58.3 years, a mean LOS of 60.3 days (median, 48 days), and a mean survival of 14.5 months. PG group patients had a mean age of 64.5 years, an average LOS of 14.3 days (median, 14 days), and an average survival of 10+ months. None of these differences were significant. Major complications in the PJ group included 2 leaks, 2 cases of pancreatic insufficiency, and 2 deaths related to the anastomotic leaks. Eleven other major complications occurred. The PG group patients did not have any leaks. One developed pancreatic insufficiency. Complications in the PG group were much less serious than those in PJ group. The longest hospital stay in the PG group was 20 days (range, 2-20) and 144 days (range, 11-144) in the PJ group. We conclude that PG is superior to PJ because of the decreased incidence of anastomotic leaks and the less serious nature of the complications associated with PG.
Aged↗